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NPI Code Detail

MEDICARE: DR. MULUALEM TESFAYE ASSEFA DDS

MEDICARE: DR. MULUALEM TESFAYE ASSEFA DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
21223G0001XGeneral Practice Dentistry0401415215VA
3122300000XDentist16016MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DEN1001790OTHERDCDC DENTAL BOARD
2MD16016OTHERMDMARYLAND DENTAL BOARD

General Provider Information

NPI Number : 1053793653
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MULUALEM TESFAYE ASSEFA DDS
Provider Business Mailing Address
First Line : 5622 COLUMBIA PIKE
Second Line : SUIT 103
City : FALLS CHURCH
State : VA
Zip : 22041-2718
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5570 SILVER HILL RD
Second Line :
City : DISTRICT HEIGHTS
State : MD
Zip : 20747-1104
Country : US
Telephone Number : 301-202-2222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2015
Last Update Date : 10/08/2020

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